Client will Editmaintain passage of soft, formed stool
every 1 to 3 days without straining by the time of discharge.

Encourage a fluid intake
of 1.5 to 2 L/day (six to eight glasses of liquids per day), unless contraindicated
because of renal insufficiency. Cereal fibers such
as wheat bran add additional bulk by attracting water to the fiber, so adequate
fluid intake is essential. Increasing fluid intake to 1.5 to 2 L/day while maintaining
a fiber intake of 25 g can significantly increase the frequency of stools in clients
with constipation (Weeks, Hubbartt & Michaels, 2000; Anti, 1998). EB:
Increasing fluid intake is not helpful if the person is already well hydrated

Provide laxatives, suppositories,
and enemas only as needed if other more natural interventions are not effective,
and as ordered only; establish a client goal of eliminating their use.
Use of stimulant laxatives should be avoided because they result in laxative dependence
and loss of normal bowel function (Merli & Graham, 2003). Laxatives and enemas
also damage the surface epithelium of the colon (Schmelzer et al, 2004).

Encourage client to resume
walking and activities of daily living as soon as possible if their mobility has
been restricted. Encourage turning and changing positions in bed, lifting the hips
off the bed, performing range-of-motion exercises, alternately lifting each knee
to the chest, doing wheelchair lifts, doing waist twists, stretching the arms away
from the body, and pulling in the abdomen while taking deep breaths.
Bed rest and decreased mobility lead to constipation, but additional exercise does
not help the constipated person who is already mobile. When the client has diminished
mobility, even minimal activity increases peristalsis, which is necessary to prevent
constipation (Weeks, Hubbartt & Michaels, 2000).
EB: Twelve weeks of physical activity significantly decreased symptoms of
constipation and difficulty defecating in sedentary clients with chronic constipation,
but transit time decreased only in subjects who had abnormally long transit time
before starting the exercise program (DeSchryver et al, 2005).

R/T

mental confusion

insufficient physical
activity

neurological impairment

decreased motility of
gastrointestinal tract

Short Term:

Client will Identify measures
that prevent or treat constipation by the end of shift on [date] at 1300.

Teach client to consume
a fiber intake of 20 g/day (for adults), ensuring that the fiber is palatable to
the individual and that fluid intake is adequate. Add fiber gradually to decrease
bloating and flatus. Larger stools move through
the colon faster than smaller stools, and dietary fiber makes stools bigger because
it is undigested in the upper intestinal tract. Fiber fermentation by bacteria in
the colon produces gas. EB: Analysis of survey data from a subset
of women (N 62,036) in the Nurses' Health Study Women found that those with a median
fiber intake of 20 g/day were less likely to experience constipation than those
with a median intake of 7 g/day (Dukas, Willett & Giovannucci, 2003).
EBN: A study protocol that included high-fiber foods that had been
tested for palatability and 1500 ml of fluid daily reduced constipation from 59
to 9; reduced laxative use from 59 to 8; and eliminated impactions in a group of
hospitalized, immobilized, vascular clients (Hall et al, 1995). EB: Researchers
found that rye bread shortened intestinal transit time, softened the feces, and
eased defecation of 59 women with constipation, and that yogurt lessened the bloating
and flatulence resulting from rye bread (Hongisto et al, 2006).

Teach client to use a
mixture of bran cereal, applesauce, and prune juice; begin administration in small
amounts and gradually increase amount. Keep refrigerated. Always check with the
primary care practitioner before initiating this intervention. It is important that
the client also ingest sufficient fluids. EBN:This bran mixture has been shown to be effective even
with short-term use in elderly clients recovering from acute conditions.
Note: Giving fiber without sufficient fluid has resulted in worsening of constipation
(Muller-Lissner et al, 2005). Additional Research:
(Howard, West & Ossip-Klein, 2000, Gibson et al, 1995; Beverley & Travis, 1992;
Neal, 1995).

If not contraindicated,
teach the client how to do bent-leg sit-ups to increase abdominal tone; also encourage
the client to contract the abdominal muscles frequently throughout the day. Help
the client develop a daily exercise program to increase peristalsis.